Talking about Keas

I’ve started a new company, Keas Inc with a partner, George Kassabgi. Since a lot of people have asked about Keas and it is too early to be giving specifics, let me talk about the vision and the culture we’re dedicated to at Keas and the people we’re looking for.

What is the Keas vision? If you are one of the many at risk of losing your health, Keas will help you keep healthy. If you’re recovering from an illness Keas will help you to recover and stay well. If you suffer from a chronic disease Keas will help you be as well as you can be. Today no one helps you. You can’t assemble your health data to get the best care possible. Even if you can, your doctors rarely help because the system doesn’t pay them to keep you healthy. You don’t have tools that work online to help in these situations, partly because insurance doesn’t pay for them. Because of these problems people suffer both personal hardship and fear and economic deprivation, sometimes irreversibly. What is more we all pay enormous medical costs for this, and there are costs to society and to the competitiveness of our companies in lost productivity. It is our mission at Keas to fix this for you. Clearly it isn’t an easy mission or a short-term one. While we think we have some great ideas about how to make this possible, we have a lot to learn in the course of this adventure.

What is our culture? We are all focused on making a great service that the customers love and that truly helps them. We want to have fun and make a difference and get it right. We want to build the service with love and care. Every day, we want to make sure that our customer experience is as good as it can be. This doesn’t mean trying to get it perfect out of the gate. Heck you don’t know until people use it. See my talk on intelligent reaction. What this does mean is pouring resources into constant improvement once the service is out of the gate and steadily learning from the usage patterns to make sure that the service quickly and surely evolves in the right direction. This requires great listening skills and great empathy and great patience and data analysis skills and, oh yes, some creative design insight. It requires the humility to realize that it isn’t your vision for how the UI should look that matters, but what actually works for the customer.

What kind of people are we hiring? We are hiring people who are really good at what they do, relaxed, persistent, pragmatic and fearless. It is important that the people who come fit this profile because in a start up everything is uncertain. You have to roll with the punches. You have to expect that your plan will change as the data starts to come in. Success in most start-ups isn’t instant. If it were easy, it would already be done. You have to keep trying. Some ideas work. Some don’t. What we’re trying to do at Keas certainly is hard. We need great people who aren’t afraid to try hard things but are willing to also look at the facts, see when something isn’t working, chalk it up to experience, and try the next hard thing. If you want predictability go to a big company.

Who are we still looking for? Engineers. We intend to keep Keas small until the ideas are proven (we’re self-funded). There is room, however, for a few engineers and for a proven development lead. In general people need to be able to get to San Francisco (we’re by Mission street and 1st Street close to everything), but we could use an engineer or two in the east coast as well or one or two willing to be there for significant periods of time. What kind of an engineer do you need to be? Well, in a word, excellent. More generally, productive, fun to work with, willing to tackle any problem, willing to work in Java or PHP or RubyOnRails, use machine learning or whatever language makes sense for the job, careful to avoid Not-Invented-Here when possible, good-humored, and burning to do something that really matters. It will be a small elite engineering team and we need it to really rock.

Why would you join? If we get this right, literally 100’s of millions of people who currently are on track to get ill or have chronic diseases and are at risk of getting still sicker will live longer and better lives because of you. In addition the ideas are genuinely interesting, hard, require thought, insight, and creativity. There is almost nothing easy in what we need to do. That means almost all of it is challenging and fun. You get to come in at the beginning of this adventure and that is always a blast. You’re going to get to work with wonderful people who care and want to make a difference. Ever since I moved into helping out in the health arena, I’ve met people I’m in awe of, people who are brilliant, caring, somehow hold down 4 jobs at once each of which would be full time for many of us, and still have happy personal lives. These people are going to love you because if this works, you’re going to be letting them run like no one else has. All you’ll have to do is work with them, listen carefully to them, and then be brilliant and quick. What more could you ask?

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32 Responses to Talking about Keas

Good luck. It’s an are so bound by insurance company and legal restrictions that the patient if left out of the plan. The sicker the patient the more the systems can’t respect them as a customer. They fall outside the system and are put out on the street.

Good luck helping people avoid that eventual fate. If it work the insurnace companies will support you in that quest. The lawyers will only target you if there’s cash.

The Doctor are probably ready to address health care through more effective education and guidance since they are finding it hard to stay profitable tending to people with a lot of problems: no one will/can cover the costs.

Adam: I am so very happy you are continuing on this important path. After seven years, I still wake up each and every morning juiced and privileged to work in healthcare (consumer) media, which is relevant and meaningful as we all try to figure out new business/service formula(s) that work for the 21st Century. I view my years at Disney and Sony as preparation. And, as Dave just said, I am available for alpha/beta testing at ANY time. We need your continued vision and leadership — and soul. Thank you, also, for staking out a qualifications base and understanding this is NOT a spint. Be well and have fun, my friend. Count me in! Renata

As someone with a chronic illness, I’d like to put forth a request that you talk to more people with chronic illnesses.

I think you’ll find it a mind expanding experience. Such people don’t really have an interest in external (non medical) sources that want to help you be as healthy as you can be.

Surprisingly, the topics and ideas that draw the most attention are:
1. The eight hour day, a nurturing lifestyle attached to just one job. A healthy mindset that promotes satisfaction at 5:00 p.m. rather than 5:00 a.m.
2. Compassionate health care systems (as example, a MS clinic in Seattle that is designed to treat the illness knowing full well they will not profit from it).
3. Web 2.0 feeds that deliver specific information without the myriad problems of finding the needle in the haystack.
4. Hotspot research issues like stem cell research and AIDS. Not because it will make us better in our lifetime, but because people will be better off after our lifetime.
5. Society’s perception of illness. We have to live in this world too.

Just as shoppers at the grocery store determine the price of mayonaise, people with chronic disease find value at various points along their treatment path. Some are tangible, most are the intangibles.

This sounds like a really exciting project and way for you to use your talents for some tremendous social good.

It’s no big secret just how messed up the U.S. healthcare system is.

And it’s hard to imagine a world without WebMD. So many people now to turn to it so supplement limited formal health care resources.

There DEFINITELY is a need for even more credible, content rich tools and Web sites to help people stay healthy and battle chronic diseases.

Plus so many aging baby boomers are Web savvy now.

I remember taking a Health Economics class back in college in the early 90’s. It’s amazing how many of the professor’s scary predictions came true. (The World would be a better place if he were wrong.)

I had the pleasure of meeting you and hearing you speak at the Connecting Americans to Their Healthcare conference (Markle Foundation) in 2006. I’m pleased to see that you are still focusing your efforts on the core ideas posed in your speech. Good luck with everything, Adam. I look forward to watching your progress.

Adam,
Ive heard and read so much about your remarkable work. In 98/99 we were way ahead of our time in eprescribing winning msft industry solutions awards at HIMMS yada yada.. The laws in the MMA should help, but nothing will help more than the consumer driven model as the reluctance we saw at the provider level was astonishing, no disgusting. The pbms are our friends and very powerful. if possible, your direct contact info for an opinion on my togetherhealth.com initiative would be awesome. best of luck,
rg

Adam, I work in a hospital setting and would be interested to speak with you about what we are trying to do here. The goal is to get patient data created at the hospital and physician offices to the patient via an electronic means (website). We have the data to be sent, but having a solution in the market is where we falter. If this is your area, let me know so we may exchange thoughts. Our though is it’s the patient data so why can’t we just give it to them? Why do they have to wait for physcians and why do they have to rely on them to hold it within their walls if it’s the patients data?

The problems created by the myth that we have a health care ‘system’ are legion. The toxic, inverted demand/suppy dynamic has successfully poisoned itself, but the new retail health care marketplace has not yet fully defined itself. New initiatives (carol.com, redbrickhealth.com, revolutionhealth, etc.) are taking shape in response to the indistinct opportunity, but the trends converge on a future that badly needs new and innovative solutions.
As someone who has worked ‘in the belly of the beast’ it’s not hard to understand that health plans are not going to be the source of creative solutions. At the same time, providers are trained in cultures that are not based on business disciplines. The hybrid survivors of business and health plan experience are seeding a new wave of experiments that are at least innovative, if not promising.
Ultimately, in my view, the issue of risk must be re-framed. It’s possible to know enough now about an individual that “perfectly managed risk” means that individual coverage products are possible–just not practical. So how new risk pools are constructed, and how individuals move between those pools, will probably be a critical dynamic in any solution.
I’m not an engineer, but engaged more on the consumer product side. Good luck; it should be an interesting journey.

Adam, Keas’s vision is admirable and on-the-mark for defining some of our current healthcare problems. Any solution, however, must confront the causes.

First, and largely unrecognized by we who are determined to solve these problems is the enormous apathy patients have toward their health and health care. and their fear of their healthcare providers. Until these are overcome we can only create push-down solutions that patients are unwilling to receive-ie the PHR solution to a patient-perceived non-problem.

The apathy and fear stem from patient’s actual ignorance about medicine (correctable), a perceived, and sometimes real, personal and intellectual inferiority to their doctors (tough, but correctable), a fear of knowing too much about their actual state of health (inborn), and, in the setting of declining access to, and actual numbers of, doctors. a fear of offending their doctor and having to find another (tough one).

Another problem is the slowly disappearing ‘medical home’. Healthcare delivery as a point source is under pressure from Concierge Medicine (decreased access), Retail (Direct) Clinics-Minute Clinics, Take Care Health, etc.-no continuity of care, Urgent Care or Walk-in Clinics-no continuity of care, the Behind the Counter Drug movement where soon Zocor and antibiotics will be dispensed, and presumably managed, by the pharmacist, more PAs ans NPs- ‘mid-levels’ practicing as primaries, Chiropractic ‘Docoters’, and the steep, serious, and worrisome, decline of medical school graduates going into primary care.

Finally, another issue is the worsening state of inferior care, medical errors, down-right doctor ignorance, poor ethics, and the lack of any systems of oversight.

To address some of these issues I formed Like a Doctor in the Family, LLC here in Sarasota to review personal medical reports, medical records and produce PHRs. Very few takers as personal health apathy reigns high. The first review, however, revealed recurrent prostate carcnoma in an ill patient whose doctor told him his PSAs were in the normal range, which they were, except he had a prostatectomy ten years earlier and his PSA values should have been zero.

In closing I would like to say that the biggest socio-medico-economic problem we face, and the one I believe is the easiest to solve is diabetes, our little $132 billion dollar problem. For all of the reasons I gave above diabetics have no source for comprehensive, consistent, standardized, and organized care.

Chronic diseases, of which diabetes is the poster-child, require unique, brave, and revolutionary approaches.

I think we need to commoditize diabetes care by taking diabetes care out of the faltering traditional care-delivery systems and applying the technology we have, perhaps Keas has, (see the 2004 Congressional White Paper on Diabetes) to create a virtual Center for Advanced Diabetes Care wherein the ADA and ACCE Standards of Care are universally applied, all necessary specialist referrals are organized and structured to qualified local providers and follow-up is automated.

I wrote a program called DbxEZ (pronounced ‘diabetes easy’) that managed the diabetes visit and used it on patients quite successfully in my practice. I presented DbxEZ to the ADA at there headquarters in Alexandria where it was enthuisastically received and used on patients.

It was very interesting reading your blog…. and I am even more impressed that you have started a company to address the “REAL” healthcare issues. We all know what a mess the system is already and it’s only going to get messier for all of us.

I have been in healthcare for the last 7 years building Physician Portals and Hospital Dashoards. AS you said the focus needs to shift to the end user – the Patient. Myself and couple of Engineers have built a beta product that will aid the end user (patient!)

All this talk about EHR and PHR and RHIO’s and interoperability. We also know that currently there is no front runner in this space…. the googles, the microsofts, the oracles have jumped into this. We will wait and see what they can come up with.

My prediction is a startup company, someone who will listen to the patients, and brilliantly (extremely simple yet superbly effective) develop a system wil be the front runner.

GO Adam and all the best. Hopefully when we get our product (a patient portal) developed, perhaps we can chat and see if there are any synergies. Jason (jan 25 blog) what is your contact number. I did love to chat with you.

Adam, I noted your new company with interest but noted your advisers with dismay. Why do you have no naturopaths, no chiropractors, acupuncturists, massage therapists, homeopaths, holistic healers? I’ve worked in alternative healthcare for many years and know from my work and my personal experience that many health conditions have subtle causes that seldom show up on traditional (allopathic) medical radar. And the healing processes for these causes would raise many MD eyebrows but result in recovery for many so who cares how many eyebrows are raised.

You’re already on your way down your road so maybe it’s too late for such a change. The human body has tremendous self-healing potential if the stressors such as negative emotion and relationships, pesticides, environmental toxins, vaccines, heavy metals, old resident bacteria and viruses, subtle and deep infections (such as in teeth, tooth sockets and bones), musculoskeletal lock-ups, impedence from scars and other interferences are removed. I myself am not an expert in this area. But I would be happy to help you any way I can in refining a vision of what causes illness.

Adam, We applaud your vision and goals. Moreover, we’d like to help you test your new products here in Hawaii. Our startup-www.mauiagewave.com- advocates the use of technology to help 75 million baby boomers age in place. We’re seeking engagements from companies like yours who want to conduct beta tests or initial marketing of proven products Hawaii offers many diverse SES, ethnic and rural test maketing segments.
What is the current stage of your new product concepts?
Thank you,peter@harvardclubofmaui.com

Adam,
Very interesting, seems like the theme make more and more sense as we are getting older. I would love to hear your ideas and discuss how I can contribute. Over the years I had sporadic access to number of related projects – medical imaging, statistical analysis, etc, but somehow the projects were blocked by institutional medical records holders as they really showed little correlation between health and current symptomatic treatment. As a result, I have been studying traditional methods lately, however, I still have high hopes of statistical analysis of the symptoms and cures as the best hope for finding cures, especially for large chronic diseases like hepatitis or diabetes.
Please let me know if I can be of any help. Lately I have been doing tons of Flex/UX, which can be also good for older people UIs.
Thank you,
Anatole Tartakovsky

The “aha” moment you describe, recognizing how a discrete daily behavior affected your personal health, is the key to health promotion. Unfortunately, it is a rare occurrence because most people are not as self-aware as you, and primary care providers have no opportunity to explore discrete behaviors with their patients to actually promote health.

I am a family nurse practitioner who works in a community health center in Crawfordsville, IN, about 40 miles west of Indianapolis. I have been working to help folks adopt healthier behaviors for almost 3 decades.

I was a neurosurgical ICU nurse for about 6 years when I had a revelation at the bedside of a patient who was injured in a motor vehicle crash of two drunken drivers who were both killed in the collision. My patient was the drunken passenger of one of those drivers. “Red” was a mid-50s married gentleman with two young adult sons, a factory supervisor who vigorously walked the aisles each day with a cigarette in his hand, who ate what he liked, and drank to excess regularly. He was in critical condition not because of a brain injury, fractured femur, tibia, fibula, and flail chest–he was in critical condition because we were fighting his years of heavy smoking, poor diet, and excessive alcohol consumption.

That evening 6 weeks following the initial collision, his wife confessed to me that she was exhausted by the ups and downs of his hospitalization, that she was also feeling incredible guilt that sometimes she wished that Red had died in the accident so that her life could have some normalcy, much like the normalcy the wives of the two drivers experienced. That evening, as I stood by his bed hanging yet another IV antibiotic to fight his pneumonia, I decided I needed to get on the “front end” of healthcare. I went back to earn a masters degree in community health nursing and then pursued certification as a family nurse practitioner.

I truly believe our nation will not be healthier until we overhaul our entire health care delivery system, followed by an overhaul in our health care payment system. We do not have enough primary care providers, as they are currently defined (physicians and nurse practitioners), to effectively promote health. I have lobbied for expansion of the roles of the registered nurse to encompass primary care, particularly health promotion and health protection. A seminal research study published two decades ago identified that 80% of patient visits to a doctor’s office/clinic could be resolved by a registered nurse–yet these visits continue to consume the efforts of health care professionals whose practice would better serve patients who are actually sick (or sicker) than those in their office.

RNs would be the best educated and most experienced resources to assist your company’s success. Their clinical expertise could be vital in the development of your company. I would be happy to talk further with you about these matters.

I read that you said that Keas aim is ““to enable people to change their lifestyles — to make them part of the solution.” The solution of Obesity, or Obese people Adam? You know who else had an idea for a solution to undesirables, his name was Adolf Hitler.

Sure you’re not sending people to death camps, you are just supporting information that claims if they STARVE themselves they will be good thin people. Aside from perhaps learning to use terminology not so close to the leader of the Nazis. You should look at:

It’s more unhealthy to diet than it is, to accept your body for it’s natural pre-set genetic weight. That’s right, weight is a matter of genetics, not someone being a slothful pig. I’m very dissapointed you are planning to use people’s health information to further the Obesity Hysteria. Maybe if you stopped and thought about how, you are sending people to their own self-caused deaths en mass, you might realize that you aren’t helping people. You simply are trying to cull the undesirables from the populus.

It is worth noting, as my recent post showed, that the percentage of obese American’s tripled in the last 20 years. Now, as we know, their genetics didn’t change substantively in those same 20 years. So I doubt very much that genetics explains the wave of obesity, not to mention that most of us derive from countries that have far far less obesity than we do. For example, Japanese Americans have greater rates of obesity than those in Japan. As to being healthy to accept your natural weight, sure, but if your BMI is 37 or 38 or 39 or 40, you are at massive risk for heart disease and/or diabetes and, consequently, at risk for blindness, renal failure and dialysis, amputations, immobility, impaired sex life and so on. It is hard to say that this is helping people.

As Lao Tzu so wisely stated “A journey of a thousand miles must begin with a single step.” I see your efforts as that first step and the 999 and so remaining miles lie between the patient’s ears or within his/her heart if you are disposed to believe the heart is a repository of courage and trust as well as muscle, blood and nerves. All the information in the world, arranged in most cogent manner possible will not make up for the fear a person experiences when dealing with the United States health care system. I had the honor of serving as a medical social worker for twenty-six years. I was invited into people’s hospital rooms and into their living rooms for the purpose of puting a human face and feeling on a healthcare system that increasing exalted robotic hands a la da Vinci while devaluing the true human touch. The true potential of empowering people to become an equal partner in their own medical care and wellness care will not be realized unless you add some type of facilitator into your mix who purpose to be an advocate in the true sense of that word.
I wish you all the best in your noble quest…..Don Quixote lives!!!!

This is a fascinating concept. I learned about the plan today through an article in the IHT. Personally I will definitely sign up when the product is ready. Like many today my wife and I frequently do research on health issues over the internet, but with varying success. In any case that research is limited to one off attempts at some marginal learning. To be able to use a comprehensive service such as you are planning with KEAS to establish a personal health profile and receive advice as well as information represents a major advance. Furthermore, I fully agree that even in the best of circumstances family doctors do not gear their service toward personalized health care, education and prevention of illness. I look forward to hearing more on the project’s advance.